A Review of Dexmedetomidine Use in Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is performed under general anesthesia, and the choice of anesthetic induction agents critically influences multiple aspects of the treatment, including the seizure quality, cardiovascular stability, and post-procedural recovery.Developing anesthetic strategies that reliably achieve loss of consciousness while preserving adequate seizure expression has been a central challenge in ECT practice because most commonly used induction agents possess anticonvulsant properties.Dexmedetomidine (DEX), recently introduced primarily for sedation in intensive care and various procedural settings, is a selective α2-adrenergic receptor agonist that has minimal impacts on the seizure threshold and seizure duration while providing a complex profile of sedation, analgesia, anxiolysis, and sympatholysis.These properties help reduce the acute increases in blood pressure and heart rate induced by electrical stimulation, and DEX also offers advantages for airway management because it induces virtually no respiratory depression.Importantly, DEX has also been consistently reported to reduce pre-procedural anxiety and postictal agitation or aggression, suggesting that it may allow more stable management throughout the entire ECT course compared with conventional anesthetic agents.This review examines the pharmacological characteristics and clinical implications of DEX in anesthetic induction for ECT and discusses its potential roles in future clinical practice.